H5N1

Cuba: A confusing cholera report

Via Hablemos Press, a dissident website in Havana: Doce fallecidos por cólera en 15 días. [Twelve cholera deaths in 15 days] This just appeared on September 8, but the dateline is August 8. I would have picked it up a month ago, and didn't. So I don't know if it's really new, or some kind of "echo post." In any case, it seems worth posting here because of its reference to the World Health Organization. But treat it with caution. Excerpt, with my translation:

La Habana, 8 de agosto.- Entre el 20 de julio y el 5 de agosto, al menos doce personas fallecieron por cólera en el Hospital Leonor Pérez del municipio Boyeros en La Habana, sin que los medios oficiales hicieran mención del caso. 

Havana, August 8: Between July 20 and August 5, at leas 12 persons died of cholera in the Leonor Pérez Hospital in the Havana municipality of Boyeros, without any mention in official media.

Un paciente, que estuvo ingresado en el Leonor Pérez durante ese periodo, por sospecha de cólera, aseguró que vio morir a doce personas a causa de ese virus infecto contagioso, provocado por la bacteria Vibrio cholerae. Según el paciente, quien prefirió no revelar su identidad, ante lo alarmante que le resultó ver cómo morían las personas sin que los medios informativos oficiales reportaran las noticias, decidió preguntarle al médico que lo atendía, porqué no se informaba al pueblo de lo que acontecía. 

A patient who had been admitted to the hospital during this period, with suspected cholera, confirmed that he saw 12 persons die from this contagious disease caused by the Vibrio cholerae. According to the patient, who preferred not to reveal his identity, he was so alarmed by seeing these deaths (unmentioned by the official media) that he decided to ask his attending physician why the public hadn't been informed about them.

“El médico me dijo, que de eso [el número de fallecidos], no se podía dar noticias, porque Cuba se encuentra entre los países más notables del mundo en la rama de la salud y que por esto recibe varios beneficios de la Organización Mundial de la Salud (OMS)", -expresó el paciente. 

"The doctor told me that they couldn't report these (the number of deaths) because Cuba is among the most notable countries in the health field. For this reason it gets various benefits from the World Health Organization," the patient explained.

De acuerdo con las explicaciones expuestas por el médico, el gobierno cubano no informa de lo que acontece por temor a que le retiren la ayuda que le brinda la OMS y otras organizaciones internacionales de la salud. 

According to the doctor's explanations, the Cuban government didn't report what had happened out of fear that WHO and other health organizations would withhold the help they supply.

“El médico me explicó que si se reportan más de cinco muertos,  el brote de cólera sería declarado como epidemia, y al país le retirarían toda la ayuda que le brindan  las organizaciones de la salud”,-argumentó el paciente. 

"The doctor explained that if they report more than five deaths, the cholera outbreak would be declared an epidemic, and the health organizations would pull all the support they provide," the patient argued.

Se hizo imposible obtener información directamente de los médicos del Hospital; sin embargo, trabajadores del área de servicio confirmaron que han sido varios los fallecidos, aunque no precisaron la cifra exacta ni el diagnóstico de la enfermedad.

It's been made impossible to obtain information directly from the hospital's doctors; nevertheless, health service workers confirmed that there have been several deaths, though they did not specify the exact number nor the diagnosis of the disease.

India: Three die of leptospirosis in Surat, toll reaches 10

Via Indian Express: Three die of lepto in Surat, toll reaches 10. Excerpt:

Three farm labourers from Surat district have died of leptospirosis while three others have tested positive for the disease that has claimed 10 lives in the district so far this year. 

The deceased have been identified as Yogesh Rathod (35), Shanta Gamit (55) and Govind Patel (40). All three were brought to New Civil Hospital where they died Friday evening. 

Hospital sources said they had earlier undergone treatment in private clinics in their villages and were brought to the hospital in Surat only a few days ago when their condition had worsened.

So three farm labourers, helping to feed a billion people, get their moment of fame in their obituaries. Their country's health system is set up to impoverish their families still more in a private clinic before passing them on to a public hospital to die in. This is a country that can afford to build nuclear weapons and launch rockets into space, but can't find the money for cheap rubber boots—never mind an adequate public health system.

Dominican Republic: Two more deaths because of cholera

Via Dominican Today.com: Two more deaths because of cholera.

Two persons with symptoms similar to cholera died in Santiago, health sources reported as the country is carrying out a campaign against several diseases. 

The two patients who died had arrived at the Jose Maria Cabral Hospital with symptoms of severe diarrhea. Julio de los Santos, 66, was from the province of Espaillat, while Oscar Antonio Lora, 64, lived in Santiago. 

Since the beginning of the cholera epidemic in Haiti in November 2010, nearly 26,712 Dominicans have been affected by the disease, and 169 deaths have been confirmed, according to statistics from the Health Ministry.

Ebola virus spreads in eastern Congo

Via Google News, a report from The Associated Press: Ebola virus spreads in eastern Congo. I assume they mean the Democratic Republic of Congo. Excerpt:

Officials in eastern Congo say the Ebola epidemic has spread to a second center after a woman was contaminated during the funeral of a victim of the disease and travelled back to her home. The health officials say 15 people have died since the beginning of the epidemic.

Canada: Research stopped by BC health ministry might have cut big pharma profits

Via The Tyee, an article by my respected colleague Andrew MacLeod: Research Stopped by Ministry Might Have Cut Big Pharma Profits. It deals with the recent firings of several employees in our ministry of health over alleged conflicts of interest. Excerpt:

None of the people contacted agreed to be interviewed for this story, in some cases citing legal advice not to speak about it with anyone while they prepare wrongful dismissal suits against the government. One said the firing appeared to be political in nature, but declined to provide details. 

The people affected had been involved in various research projects over the years that were aimed at saving the public money on drugs, work that had the flip side of cutting into drug company profits. 

Mattson and Maclure, for example, were involved in the Alzheimer's Drug Therapy Initiative, project whose tasks included gathering the evidence on drugs used to treat the disease and making recommendations to the ministry on whether or not it should pay for them. A recommendation against using the drugs could be very expensive for the companies that make them. 

Another project that takes physicians' prescribing patterns and compares them to what the evidence says are the best practices expired on Aug. 31. The project, aimed at both reducing unsafe prescribing and saving the government money, had assessed several drugs already and researchers planned to look at several more. 

There were questions too about how the investigation may affect the Therapeutics Initiative, a UBC body that holds contracts to assess drugs for the government, and whose future was in question starting in 2008 when a government report recommended replacing it. Already the group's access to data has been cut off, along with that of other researchers. 

The B.C. Government Employees' Union has reportedly said it is working on grievances on behalf of its three members who were fired.

Haiti’s cholera a story of failed leadership and politics

Via The Star, columnist Catherine Porter has a long report: Porter: Haiti’s cholera a story of failed leadership and politics. She cites the dubious "112,000 cases in 2012" statistic, and gives the UN too much benefit of very little doubt about the origins of cholera in Haiti. Still, it's an important summary. Excerpt (but read the whole article):

Almost two years after the deadly disease first appeared in Haiti in the aftermath of the Jan. 12, 2010 earthquake, the story of cholera is one of both success and failure. 

The success? Statistically, the death rate has been beaten back to below 1 per cent from its peak of 9 per cent in December 2010. Fewer people are contracting the disease. Those who do are quicker to seek treatment. The initial stigma around the disease has dissipated. 

Much of that success, though, stems from the frenzied work of aid groups that jumped into action, setting up treatment centres in refugee camps, organizing community brigades in the countryside and dispersing basic prevention supplies, such as soap and chlorine tablets. 

Right after the outbreak, these aid groups were flush with money. Since then, however, their donations have dried up and most have ended their cholera programs. In the central province of Artibonite, for example, the 22 organizations that worked on cholera last year have dwindled to seven. 

Last week, U.N. chief Ban Ki-moon warned that the number of cholera cases was again growing in Haiti, citing a World Health Organization prediction that there could be 112,000 cases in 2012. 

In most instances, the Haitian government has not picked up the work that had been done by departing aid agencies. That was evident this past April, during the rainy season, when cholera infections traditionally spike. 

“If we weren’t here in April, it would literally have been a disaster,” says Oliver Schulz, the chief of mission for Medecins Sans Frontiers (Doctors Without Borders), which runs the centre treating Castin. “We treated 72 per cent of the cases of cholera in Port-au-Prince and Leogane — around 10,000. Other organizations were shutting down their centres and referring patients to us. 

“This shouldn’t be our role. We are an emergency medical organization. Two years after the outbreak, the government should be running these centres,” he says. 

Compared to the peak of the outbreak, when more than 2,400 people arrived at cholera clinics every day, 10,000 cases might seem like progress. But, Haiti — a country of only 10 million — has more cases of cholera than all of Africa, Schulz points out. Any river seems languid compared to a waterfall. 

One year before cholera appeared in Haiti, there were around 221,000 reported cases and 4,950 deaths to cholera globally, according to the World Health Organization. In less than two years, little Haiti has seen more than 586,000 cases and 7,500 deaths to cholera. 

“Normally, with 1,000 cases, you think ‘epidemic,’” Schulz says. “How come everyone thinks it’s fine here?”

US: West Nile virus deaths reach 46 in Texas

Via Xinhua: West Nile virus deaths reach 46 in U.S. state of Texas. Excerpt:

There have been at least 46 deaths from West Nile virus in Texas this year, local media reported Friday. 

The latest deaths were reported in Dallas County and El Paso County on Thursday, with each county confirming one West Nile virus death, according to local TV channel ABC13. 

Amid a nationwide outbreak of West Nile virus cases, Texas is the worst hit state. 

The state is seeing the worst year ever for West Nile virus, reporting almost 45 percent of the nation's total West Nile cases, and about half of the deaths. 

Latest figures show that West Nile virus cases reported in Texas so far this year totaled 1,013, more than doubling the previous high, among which are at least 523 cases of neuroinvasive West Nile, the most serious form of the illness because it affects the nervous system. 

In 2003, Texas recorded 439 neuroinvasive cases. 

The number of West Nile virus cases reported across the United States as of early September is also the highest since the disease was discovered in the country in 1999, federal officials said. 

As of Sept. 4, 2012, 48 states have reported West Nile virus infections in people, birds or mosquitoes. Over 70 percent of the cases have been reported from six states, namely Texas, South Dakota, Mississippi, Oklahoma, Louisiana and Michigan.

India: Mrs. Sheikh's untreatable TB

Via The Wall Street Journal: A Woman's 'Untreatable' TB Echoes Around the World. Excerpt from a long article:

MUMBAI—As dawn broke on July 16, a tiny woman pushed a metal trunk aboard a train, pausing a moment to cough into the green-and-black-print scarf around her head. Her husband carried a comically large water jug. 

"You've decided to travel with Powai Lake," Rahima Sheikh quipped to her husband, referring to a lake near the city of Mumbai. She helped him stow the jug under their seat. 

Then, promptly at 6:35 a.m., the Gorakhpur Express heaved out of the station, carrying Mrs. Sheikh on a 1,000-mile journey home, where she expected to die. 

Last year, Rahima Sheikh became one of India's first documented cases of tuberculosis that is resistant to virtually every medicine approved to treat it. 

Over the past six years, Mrs. Sheikh, 40 years old, mortgaged her family's rice fields, spent her father's and brother's life savings, and crisscrossed India in search of a cure for tuberculosis. But instead of getting healthier, Mrs. Sheikh grew increasingly resistant to medication with each failed treatment. 

This year, Mrs. Sheikh became one of India's first documented cases of TB that is resistant to virtually all the medicines approved to treat it. 

In recent decades, tuberculosis, a fatal infection characterized by the coughing of blood, was generally treatable. The Wall Street Journal reviewed years of Mrs. Sheikh's medical records, interviewed her doctors and TB workers across India and traveled with her as she pursued treatment. 

Her six-year journey to all-but-incurable TB exposes a blind spot in an Indian medical bureaucracy that, for decades, neglected to implement widespread testing or treatment for drug-resistant strains. As a result, a curable disease has mutated into a killer. 

The global community is worried about the danger. Health officials have urged India and other countries with increasing drug resistance to take stronger action. And this year the U.K. added India to the list of countries whose citizens must be tested for TB to obtain a visa of six months or more. 

India has no national count of patients resistant to one or all of 12 commonly used TB drugs. The government cites a study in the state of Gujarat showing less than 3% of patients there are resistant to at least the two most-powerful ones. 

Experts say these figures far understate the problem. For example, the Mumbai hospital that reported four fully drug-resistant patients this past December, had counted 15 by May. Since then, the hospital has stopped counting because of the controversy created by the bad publicity, according to the head of the lab.

Dengue fever kills 124 Cambodian children in 8 months

Via My Sinchew.com, a Xinhua report: Dengue fever kills 124 Cambodian children in 8 months. Excerpt:

At least 124 Cambodian children were killed by dengue fever in the first eight months of this year, a 158 percent rise from only 48 deaths in the same period last year, according to the report of the National Center for Parasitology, Entomology and Malaria Control on Saturday. 

Some 30,760 dengue fever cases were reported during the January- August period this year, an increase of 179 percent compared with 11,020 cases in the same period last year, the report said. 

The province with the highest death toll is Banteay Meanchey with 20 deaths, followed by Siem Reap with 18 deaths and Kampong Cham with 16. 

Dr. Char Meng Chuor, director of the center, said that among the fatal cases, 70 percent of the patients died of gastrointestinal bleeding. 

"There were more deaths this year because parents had sent their sick children to private clinics first. When the treatment was ineffective and the disease became more severe, they continued to send them to public hospitals, but it was too late for them to be cured," he said.

Canada: Quebec Legionnaires' outbreak under control: health chief

My wife and I arrived in Quebec City this afternoon on the train from Montreal. So of course this Montreal Gazette report is welcome news: Quebec Legionnaires' outbreak under control: health chief. Excerpt:

Quebec City's public health chief says the Legionnaires' disease outbreak that has plagued that city appears to be under control. 

Dr. Francois Desbiens says the actions the city's public health department have taken to get building owners in the outbreak zone to disinfect cooling towers appears to be bearing fruit. 

The city is reporting one new case of Legionnaires' today, bringing the total in the outbreak to 176. 

But there have only been three new cases this week, a significant slowing of the case count from earlier in the outbreak. 

To date 11 people have died in the outbreak, which began in July.